System and method for implementing healthcare fraud countermeasures

ABSTRACT

A method of discouraging healthcare fraud in conjunction with providing a health care service to a patient in which the patient provides a biometric signature. An event record is created where the event record creates an association between the biometric signature, a patient identifier, and location information indicating a location at which the biometric signature is obtained. The event record is stored in a central data store and can be later retrieved to verify the patient was present at the location.

This application is a continuation of U.S. Ser. No. 10/348,931 entitledSYSTEM AND METHOD FOR IMPLEMENTING HEALTHCARE FRAUD COUNTERMEASURESfiled on Jan. 22, 2003 which is incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates, in general, to systems and method fordiscouraging fraud, and, more particularly, to software, systems andmethods for discouraging and preventing healthcare fraud.

2. Relevant Background

In the United States, for example, more than 4 billion health insurancebenefit transactions are processed every year. These benefittransactions are handled by private health insurance plans as well astax-funded insurance programs such as Medicare and Medicaid. Healthcarefraud is the deliberate submittal of false claims for reimbursement tothese private health payers and public programs. In either case, societyat large ultimately suffers from these loses of healthcare fraud throughhigher health insurance premiums, restricted benefits, higher taxes andhigher insurance co-payments for privately and publicly insuredpatients.

Even though only a small percentage of these transactions arefraudulent, the total value of the losses caused by this fraud isstaggering. The National Health Care Anti-Fraud Association reports thathealth care fraud resulted in theft of $1.3 trillion in calendar-year2000 alone. On Feb. 21, 2002, the United States Department of Health andHuman Services reported its finding that of the $191.8 billion in claimspaid in 2001, 6.3 percent—amounting to $12.1 billion—should not havebeen paid due to erroneous billing or payment, inadequate providerdocumentation of services to back up the claims and/or outright fraud.

One of the largest single sources of health care fraud is dishonesthealth care providers (e.g., physicians, chiropractors, osteopaths, andalternative-medicine care givers). Although the vast majority of healthcare providers are honest, the dishonest minority are uniquely situatedto conduct systemic, ongoing and broad scale fraud that has been, untilnow, difficult to detect and prove. For example, health care providershave access to patient identities and insurance/Medicare/Medicaidinformation of those patients, knowledge of the reimbursement processes,access to the provider reimbursement systems, and a familiarity withfraudulent claims that are difficult to detect.

A common fraud involves billing for services that were never rendered.This may involve using genuine patient information to fabricate entireclaims or may involve padding claims with charges for procedures orservices that did not take place. In a common scenario, a health careprovider gains authority to perform a series of treatments over a periodof time, then performs only some of the treatments while submittingreimbursement for the entire series. While current regulations require apatient signature indicating that services were performed, a dishonestprovider often convinces the patient to sign these verification forms inadvance. The patient may or may not be aware of the fraud. Currently,unless the patient discovers and informs the insurance company orgovernment program that they did not receive the services, the fraud isdifficult to detect.

The existence of dishonest providers harms the vast majority of honestproviders in that all providers are subject to increased scrutiny, morecomplex forms, and allegations of fraud stemming from innocent mistakesin handling claims. As a result, fraud creates a chilling effect on allhonest care providers that desire to give their patients the best carepossible. This chilling effect impacts courts, regulatory agencies, andthe legal system as well as the existence of fraud creates a cloud ofdoubt around all people who submit or prosecute claims for health carereimbursement on behalf of victims of accidents, on-the-job injuries,and other legitimate reimbursable claims.

The current response to healthcare fraud involves creating criminal andcivil penalties for abuse. While such steps are necessary, they havelimited effect unless the fraud can be discovered and proven. Discoveryis difficult and insurance companies and government agencies areexpending greater and greater resources in anti-fraud processes. Morerecently, “whistleblower” programs are being used to encourage fraudreporting by patients themselves. However, because patients implicitlytrust their healthcare providers and often lack the sophisticatedknowledge to detect fraud, these programs have limited effect.

Technological solutions have been proposed that involve collecting dataabout healthcare transaction and using data mining and sophisticatedmatching techniques to identify some types of fraud. While such systemscan be useful in detecting some fraud such as double billing, overprescription, and the like, they are not generally useful to detect allfraud relating to submission of claims for services that have not beenprovided. These solutions rely on databases that hold detailedinformation about patients and medical histories of those patients. Newregulations under the health insurance portability and privacy act makeit more difficult or impossible to collect and use such information.

Accordingly, a need exists for systems, methods, and software thatdiscourage and prevent healthcare fraud.

SUMMARY OF THE INVENTION

Briefly stated, the present invention involves a system that usesbiometric information unique to an individual combined with locationinformation to create a persistent record indicating that a particularperson was physically present at a particular place. Specifically, thepresent invention provides methods of discouraging healthcare fraud inconjunction with providing a health care service to a patient in whichthe patient provides a biometric signature. An event record is createdwhere the event record creates an association between the biometricsignature, a patient identifier, and location information indicating alocation at which the biometric signature is obtained. The event recordis stored in a central data store and can be later retrieved to verifythe patient was present at the location. In terms of deterring healthcare fraud, the invention makes it significantly more difficult tosubmit claims for healthcare services that were not provided andsignificantly easier to detect a variety of fraudulent or erroneousreimbursement practices.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a networked computer environment in which the presentinvention is implemented;

FIG. 2 shows an exemplary patient interface station that may be used ina health care providers location in an implementation of the presentinvention;

FIG. 3 illustrates an embodiment of a patient record in accordance withthe present invention;

FIG. 4 illustrates an alternative embodiment of a patient record inaccordance with the present invention;

FIG. 5 is an exemplary information set used for an initial enrollmentoperation in accordance with the present invention;

FIG. 6 is an exemplary information set used to record a particularpatient event in accordance with an embodiment of the present invention;

FIG. 7 illustrates in simplified flow-diagram form front-end processingactivities in a particular embodiment; and

FIG. 8 through FIG. 11 show alternative back-end claims processingevents in accordance with various embodiments of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In a particular implementation, the present invention involves a systemthat uses biometric information unique to an individual to verify that apatient is physically present at a place of treatment (i.e., in a healthcare providers office). Biometric systems have been used to identify andauthenticate individuals in a variety of contexts. These systems, forexample, create a database containing biometric information about aplurality of known or authorized individuals. Prior to performing aservice for the individual, a fingerprint scan, or other biometricsignature, of an individual is taken and the scan information is used toaccess the database. The database returns other information such as theindividual's name, photograph, signature, or the like that can be usedto authenticate the identity of the individual.

Unlike these prior systems, however, the present invention is notprimarily concerned with identifying an individual or authenticatingthat an individual is who he/she represents himself/herself to be. Whilethe present invention could operate in conjunction with such systems,such operation is not required. Instead, the present invention desiresto create a record, called an “event record”, that records that aparticular individual was at a particular location at a particular time.This simple record does not require a database of authorized users orsophisticated matching algorithms to correlate biometric informationwith stored biometric records, although the biometric informationobtained by the present invention may also be used in conjunction withthese identification/authorization systems. Unlike prior systems, theevent record is preserved in a database for future reference should itbe necessary to validate the individuals presence at a particularlocation.

The present invention is illustrated and described in terms of adistributed computing environment such as an enterprise computing systemusing public communication channels such as the Internet. However, animportant feature of the present invention is that it is readily scaledupwardly and downwardly to meet the needs of a particular application.Accordingly, unless specified to the contrary the present invention isapplicable to significantly larger, more complex network environments aswell as small network environments such as conventional LAN systems.

The present invention is described in terms of several specificimplementations which use specific data record formats, data gatheringdevices, and protocols. It should be understood that, unless stated tothe contrary, the present invention is readily modified and extended touse other formats, devices, and protocols that are available to aparticular implementation. For example, fingerprint scanners are awidely available, cost effective biometric tool used in the specificembodiments, but any type of biometric signature may be used includingface recognition, retinal scan, voice recognition, gait recognition, andthe like, so long as the biometric technique generates a unique digitalsignature that can be captured and stored. Moreover, the presentinvention is particularly useful in discouraging healthcare fraud, butmay be used in any application where it is desirable to create anauditable record of where an individual is at a particular time.

FIG. 1 shows an exemplary computing environment in which the presentinvention may be implemented. Environment includes a plurality ofentities that are coupled by a data communication network such asInternet 101 and/or public switched telephone network 111. It should beunderstood that any available network technology such as local areanetwork (LAN) and wide area network (WAN) technology may suitable toimplement communication network 101 in particular applications. As shownin FIG. 1, the present invention provides a system and method forimplementing data communications between various healthcare serviceproviders 103 and payer entities 107 that provide insurancereimbursement for healthcare services. Health care providers 103include, for example, physicians, clinics, hospitals, dentists,pharmacies, and the like. Health care providers 103 may include any typeof traditional or alternative medicine, physical therapy, nutritionalsupport, and mental health care that are available.

In accordance with the present invention, each health care provider 103is associated with an identifiable physical location at which patientsor clients receive services. When a patient or client visits the healthcare provider location, one or more records 105 of that visit, called“event records”, are generated and transferred to event record archiveservices 109. Various types and formats of event records 105 arecontemplated by the present invention, but an important record typeincludes biometric signature information of the patient, a uniqueidentification of the healthcare provider 103, and a timestampindicating when the patient visited the healthcare provider 103.

Payer entities 107 have obligations to reimburse health care providers103 for certain claims when services are provided to insured patients.Currently, payers 107 essentially reimburse all claims made by healthcare providers 103 on the assumption that all of these claims are validabsent some indication of dishonesty. Because of the complexity of boththe insurance industries and the health care services industry,detecting fraud has been difficult.

In accordance with the present invention, central event storage servicesentity 109 retains and archives records 105 in a data store 113. In aparticular example, these records are maintained on a patient-by-patientbasis and include an auditable history of visits by a patient to one ormore health care providers 103 including the date and time of suchvisits. Using this information, a particular claim for reimbursement canbe readily correlated to a particular record to verify that a patientwas at least present at the health care provider's location at the timethe services were rendered. In some implementations the event storageservices 109 will provide information to appropriate payer entities sothat claims management software processes implemented by the payer 107can be used to verify claims. In other implementations event storageservices 109 will implement the validation processes. In yet otherimplementations, event storage services 109 acts as a clearinghouse tovalidate claims before they are submitted to payers 107. In yet otherimplementations, requests for validation and/or transfer of records 105can be handled over PSTN 111 using either data or voice communicationchannels. The selection of the particular implementation or group ofimplementations can be readily altered to meet the needs of a particularapplication.

As shown in FIG. 2, each health care provider 103 location is outfittedwith computing hardware and software that implements a patient interface201. Patient interface may be implemented as a stand-alone system orintegrated with existing practice management software used to recordpatient appointments, patient records and/or handle patient billing orother office tasks. In many health care provider locations it is commonto have a patient log-in or sign-in that is used each patient visit tonotify the health care provider of the patients arrival, and similarlyoperated by the provider's staff to note the patient's departure. Thesesystems are good candidates for integration with the present invention.

Patient interface 201 is coupled to or includes a biometric signaturedevice 203. In the particular implementation this device comprises afingerprint scanner such as a “hamster” sold by SecuGen BiometricSolutions of Milpitas, Calif. or a Morphotouch by Sagem Morpho, Inc. inTacoma, Wash. However, the present invention is largely vendorindependent and a number of alternative fingerprint scanning devices areavailable. Moreover, biometric signature device 203 is readilyimplemented using any available device that is capable of generating aunique signature based on the physical presence of a person at thepatient interface 201. In the case of a fingerprint scanner, biometricsignature device 203 outputs a binary sequence of a preselected length(e.g., 128-byte or 512-byte, etc.) that is referred to as thefingerprint minutia.

Patient interface 201 desirably includes mechanisms to reliablydetermine a date/time at which the biometric signature was captured.This is readily implemented by a system clock in a conventional computersystem, or by obtaining clock signals from external sources. In someimplementations the patient interface includes mechanisms and softwarefor providing location information. The location information can befixed in the patient interface in the form of a stored value, such asthe health care providers identification number. Alternatively, thisinformation can be provided by geographic locating systems such as theglobal positioning system (GPS) and the like.

Patient interface 201 uses this biometric signature to generate one ormore types of messages. Patient interface 201 implements two importanttypes of transactions in a particular invention. Initially, a patient isenrolled or registered to initiate creation of a patient record withevent storage system 109 using an “enrollment record” 501 shown in FIG.5. A similar record can be used to update patient information in apatient record stored in event storage system 109. Subsequently, patientvisits result in an “event record” 601 shown in FIG. 6 that is used toupdate the patient record with event storage system 109. In oneimplementation, the event record transports the biometric signature(e.g., the fingerprint minutia) to central event storage 109 so that anyprocessing of the biometric signature occurs at event storage system 109rather than within patient interface 201. Alternatively, the patientinterface 201 requests reference biometric signature information fromevent storage system 109 which enables processing of the biometricsignature to be performed in a distributed fashion at the health careprovider location.

Patient interface 201 includes, for example, processes to prompt thepatient to identify himself/herself and operate the biometric signaturedevice 203. The patient identification may involve typing or speaking aname, ID number, social security number, insurance identification, orsome other information that is substantially unique to the patient.Alternatively, the biometric signature can itself be used to identify apatient, although such an implementation involves somewhat more complextechnologies in that the signature needs to be matched against adatabase of biometric signatures to distinguish the patient.

An enrollment transaction can be initiated automatically orsemi-automatically in response to determining that a patient record doesnot exist. In this case the patient is prompted using interface 201 toprovide additional information such as date of birth, address, phonenumber, insurance information and the like to meet the needs of aparticular application. The biometric signature and other informationgathered are packaged into a data packet containing appropriateheader/trailer information and a command code indicating a particulartransaction (i.e., enrollment or update). The data packet may beimplemented as an XML document in a particular implementation. Theformed record is transferred, using encryption if desired, to eventstorage system 109.

FIG. 3 and FIG. 4 illustrate two alternative types of patient records301 and 401, respectively, that are useful in the practice of thepresent invention. Patient records 301 and 401 comprise persistent datarecords stored in data store 113 event storage system 109. It should beunderstood that FIG. 3 and FIG. 4 present conceptual representations ofa patient records and that particular hardware and/or databasemanagement systems will typically determine the physical implementationof the data structure. However the data structures shown in FIG. 3 andFIG. 4 depict the relationships between information intended by thepresent invention. Also, the records 301 and 401 can be augmented withany type and variety of additional information to meet the needs of aparticular application.

Record 301 comprises a first portion 303 that includes patientidentification information and a number of entries where each entryrefers to a specific patient visit. The patient ID field comprisesunique information about the patient such as social security number,date of birth, address, an assigned ID number, phone number, insuranceinformation, and the like. In a simplified example, each patient record301 contains a unique social security number that is used to access thepatient record 301.

In the embodiment of FIG. 3 patient record 301 includes a referencefingerprint minutia. This reference minutia is compared to the minutiaincluded with incoming event records 105 to determine matches whichindicate that the patient that generated the event record 105 isverified to be the same person associated with the patient record 105.The plural entries each contain sufficient information to indicate eachtime a patient has visited a given provider. Any number of entries maybe included in a patient record 313.

Patient record 301 also includes a lower portion 305 that serves as anaccess log or journal. Portion 305 comprises an arbitrary number ofentries where each entry identifies an event entry from the portion 303,and records access information such as when and who requested access toa particular entry within patient record 301. In particularimplementations the entries in lower portion 305 may include variousmetadata describing the access request that might record individualcredentials of the person causing the access, command codes indicatingthe nature of the request (e.g., read or modify), and/or a purpose codeindicating to what use the information would be used. This log/journalinformation can be used later to verify and demonstrate the integrity ofthe data.

The embodiment of FIG. 4 is substantially similar, but differs from thatof FIG. 3 in that each entry in upper portion 403 includes a persistentrecord of the fingerprint minutia for a particular event record 601.Although storage requirements may be increased significantly, the actualfingerprint minutia can be accessed at any time and compared against agiven person's to prove authoritatively that a patient record 405belongs to a particular individual, and to demonstrate the whereaboutsof that individual as represented by event entries stored in upperportion 403. Log/journal portion 405 is substantially identical tolog/journal portion 305 described hereinbefore.

FIG. 7A shows important activities in “front-end” processing used toenroll patients and gather event records in accordance with anembodiment of the present invention. At a healthcare provider'slocation, a patient is instructed or prompted to operate patientinterface 201 so as to obtain a biometric signature. Additionally, thepatient may be prompted to provide other identification information suchas an ID number, name, social security number and the like. Thisinformation is compiled into an event record, which is transmitted toevent system 109.

Event storage system 109 uses the event record information to identify apatient record 301/401 that corresponds to the event record. Forexample, where patient records 301/401 are indexed by social securitynumber, the social security number information in an event record can beused to identify a particular patient record. In cases where the patientrecords 301/401 are indexed by fingerprint minutia, the fingerprintminutia within an event record is to identify a particular patientrecord. When it is determined that a record exists, the presentinvention initiates processes that update the patient record with a newentry that records the patient visit to the health care provider 103.

When it is determined that a patient record does not exist, the presentinvention requests additional detailed information that is desired toestablish a new patient record 301/401. Patient interface 201 implementsprocesses to obtain the desired information, and generates an enrollmentmessage 601 back to event storage system 109. Event storage system 109creates the new patient record, and updates the new patient record toreflect the current event record information (i.e., provideridentification, timestamp, and the like). Optionally, the event storagesystem 109 will send an acknowledgement message to the patient interfaceto confirm that the patient record has been successfully updated. Thisacknowledgement message can be used to generate a receipt of some kindfor a patient. In the event an acknowledgement message is not received,patient interface 201 may cache the particular request for laterhandling.

FIG. 7B shows activities in an alternative “front-end” processing systemused to enroll patients and gather event records. An importantdifference in comparison to the embodiment of FIG. 7A is that in theembodiment of FIG. 7B, matching the “instance” biometric signature to areference biometric signature occurs in processes executing at thehealthcare provider location rather than in the central event storagesystem 109. This enables the workload involved in matching biometricsignatures to be distributed out amongst the many participatinghealthcare provider systems, freeing resources in event storage system109. The provider system then informs event storage system 109 whether amatch was determined, and the biometric signatures can be destroyed inthe provider's system.

In either the embodiment of FIG. 7A or FIG. 7B the system may use anyavailable matching algorithm to determine a suitable match between thecaptured biometric signature and a reference biometric signature. Thesealgorithms, often supplied with the biometric device 203, may produce abinary (i.e., yes/no) output, or may produce a variable outputreflecting a degree of confidence in the match. In the vast majority ofcases, once a patient is enrolled subsequent visits to a health careprovider will result in a match between a captured biometric signatureand the reference signature. In response to this match, the event recordinformation is added to the patient record at central event storagesystem 109.

In some instances a biometric signature that is captured will fail tomatch the reference biometric signature for a particular patientidentification. This can occur when, for example, the patientidentification value is entered incorrectly. This can also occur whenthe person supplying the biometric signature is not operating the device203 properly. In these cases, a failure to match results in a responsiveaction such as prompting the patient to re-enter identificationinformation or to repeat the actions involved in capturing a biometricsignature. When these actions are re-performed, it can be once againdetermined whether a match exists.

Of course, in some instances a captured biometric signature will fail tomatch a reference record because the human being that is submitting thecaptured biometric signature is different from the human being thatsubmitted the reference record. In such a situation, although a higherlikelihood of fraud exists, the present invention does not attempt tonotify a health care provider or restrict access to the health careservices. Instead, an event record is created that indicates thevariance or exception condition to signify that a match was not found.An event record with an exception condition recorded will readilyindicate a reimbursement claim that should be treated with specialattention.

In some cases it is valuable to be able to verify that a patient was notonly present at the healthcare provider's location, but also that thepatient was present for a certain amount of time. For example, if atreatment should require thirty minutes to perform, the patient will bepresent for the entire thirty minutes. In these cases, a patient may beprompted to submit biometric signature data at the beginning and endingof a visit, or at several times during the visit when appropriate. Thevisit is then recorded by multiple event records, or by a single eventrecord that indicates a time during the visit as well as an extent oftime for the visit. Although such an implementation is a slightimposition on the patient, it creates a greater disincentive to fraud.Moreover, such data can be used to detect new types of fraud such as apractice of submitting claims for a complex treatment when in fact asimpler procedure was used. Also, event records for a given health careprovider can be audited to determine whether claims are being submittedfor multiple patients who were being treated at the same time, or forsubmitting multiple claims where the aggregate time spent providingtreatment is greater than the actual time spent at the health carefacility.

Significantly, because it is contemplated that the healthcare serviceswill be provided whether or not an acknowledge is received, it isacceptable to delay transmission of event records and/or enrollmentrecords to well after the patient visit. In contrast, some prior systemsthat condition providing services upon receiving an authentication ofthe patient become extremely dependent on receiving an acknowledgment inreal time. Further, because it is contemplated that the healthcareservices will be provided whether or not a biometric signature match isdetermined, the present invention is very robust in response to errors,delays, equipment failures and communication difficulties that mightotherwise interfere with a time-sensitive decision as to whether careshould be provided.

FIG. 8 through FIG. 11 illustrate four exemplary process flows forhandling the “back-end” or reimbursement transactions using thebiometric techniques in accordance with the present invention. Tosimplify illustration and understanding, FIG. 8 through FIG. 9 operatefrom an assumption that a patient has been enrolled. In such cases, apatient visit to a health care provider involves generating a new eventrecord, which is transmitted to event storage system 109 and used toupdate an existing patient record 301/401.

In each of the embodiments shown in FIG. 8 through FIG. 11, claims forreimbursement arriving from the various providers are validated bymatching to an event record for a particular patient from event storagesystem 109. Payment is made to the appropriate provider for validatedreimbursement claims. In some instances an event record corresponding tothe claim for reimbursement will not exist, or the matching event recordwill include information that a variance or exception condition existedwhen the matching the biometric signature provided at the time ofservice with the patient's reference biometric signature. In suchinstances, the payer will likely require additional investigation and asituation-dependent response to paying the reimbursement claim.

In the first model shown in FIG. 8, event storage system 109periodically generates batch summary reports for each subscribing payerentity (e.g., insurance company, government agency, and the like). Thesereports include information indicating when each covered patient visiteda health care provider. In this model, the payer entity takesresponsibility for matching these recorded patient visits to submittedclaims using any available matching algorithms.

In the second model shown in FIG. 9, event storage system 109 is used toverify claims from health care providers before they are submitted to apayer entity. In this manner, the payer entity can operate with a highdegree of assurance that the claims they are processing are valid. Atthe same time, the payer entity does not need to modify their ownsystems and software as claim verification processes are implemented byevent storage system 109. Optionally, event storage system 109 providessummary reports indicating claims that were not validated so that thepayer entity can follow up with further investigation.

In the third model shown in FIG. 10, event storage system 109 acts as aclearinghouse by validating claims one at a time or in small groups. Inthis implementation providers deal with payers in a substantiallyconventional fashion. Upon receipt of a claim the payer will requestverification either by sending a verification request such as an XMLmessage, or by an automated phone system similar to that used to obtaincredit card authorizations. Event storage system 109 can handlevalidation of these requests very quickly in most cases as the requestsare typically small and the database lookup involved is simple. Thisalso ensures that the payer is using fresh data with up-to-the-minutecollection of event records in each patient record 301/401.

In a fourth model shown in FIG. 11, event storage system 109periodically receives batch claim reports from each subscribing payerentity. Like the model shown in FIG. 9 and FIG. 10, event storage system109 is responsible for validating claims, however, the embodiment ofFIG. 11 allows this verification to occur in batch processes which maybe more efficient than one-at-a-time processing. Event storage system109 can provide a batch response indicating yes/no information for eachclaim. In actuality, event storage system 109 need only provide a listof claims that are not validated as the payer entity can assume anyother claims are validated.

The systems and methods of the present invention have broadapplicability outside of the health care claims processing industry. Ina sense, the present invention can be used like a watchman's clock tocreate a record that verifies the location of a particular person at aparticular location and time. There is a growing problem, for example,in government provided services such as child protective services andparolee monitoring caused by government officials that fail to visittheir wards when they are supposed to. The present invention is readilyimplemented in a handheld device in which the time and location of ameeting with a protected child, for example, can be recorded by scanningthe fingerprint of the child. This system would operate to verifymeetings with parolees or other persons for which there is aresponsibility to monitor. These devices can be readily integrated withlocation devices and software, such as global positioning systems, toprovide information about the location of such meetings.

Although the invention has been described and illustrated with a certaindegree of particularity, it is understood that the present disclosurehas been made only by way of example, and that numerous changes in thecombination and arrangement of parts can be resorted to by those skilledin the art without departing from the spirit and scope of the invention,as hereinafter claimed.

1. A method of discouraging phantom billing healthcare fraud comprising:providing a health care service; in conjunction with providing saidhealth care service at a particular location to a patient, causing saidpatient to provide a biometric signature; capturing said biometricsignature; creating an event record that records said patient was atsaid particular location at a particular time and/or date, said eventrecord consisting of a patient identifier, said biometric signature, andlocation information indicating said particular location at which saidbiometric signature is obtained and at which said health care service isprovided and said event record indicates the absence of phantom billing,wherein said event record is created using a computer system;transmitting said event record including said biometric signature to acomputerized data store; and communicating information related to saidevent record to a payer entity.
 2. The method of claim 1 furthercomprising making a reimbursement decision by said payer entity usingsaid information related to said event record.
 3. The method of claim 1further comprising storing said event record in a computerized datastore.
 4. The method of claim 1 wherein said act of storing said eventrecord is performed before said biometric signature is used to identifysaid patient receiving said healthcare services.
 5. The method of claim1 wherein said act of storing said event record is performed before saidbiometric signature is used to authenticate said person receiving saidhealthcare service.
 4. The method of claim 1 further comprisingobtaining a biometric signature at least twice during said provision ofhealth care services.
 5. The method of claim 1 further comprising:receiving a claim for reimbursement for said health care services;retrieving one or more event records corresponding to said health careservices from said data store; matching said claim for reimbursement toan event record for a particular patient to determine whether said oneor more event records indicate that said patient was at a suitablelocation for reimbursing said health care services; and authorizingfinancial reimbursement of said health care service based in part uponsaid determination that said patient was present at a location suitablefor reimbursing said health care service.
 6. The method of claim 1further comprising: retrieving one or more records from said data store;and performing a fraud detection process using said retrieved records.7. The method of claim 1 wherein said biometric signature comprises afingerprint record.
 8. The method of claim 1 wherein said locationinformation comprises an identification code assigned to a heath carefacility.
 9. The method of claim 1 wherein said location informationcomprises a network address of a computer used to obtain said biometricsignature.
 10. The method of claim 1 wherein said location informationcomprises a device address of a fingerprint scanner.
 11. A biometricaudit trail system comprising: means for obtaining biometric informationfrom a person at a particular location, said particular location beingassociated with a location identification; a biometric record consistingof said biometric information and said location identification; a datastorage system for storing said biometric record with a plurality ofother biometric records; and processes for retrieving biometric recordsat a later time and/or date from said data storage system to auditlocations visited by particular persons.
 12. The system of claim 11further comprising processes operable to analyze said retrievedbiometric records to identify patterns amongst a plurality of biometricrecords.
 13. The system of claim 11 wherein said biometric recordfurther comprises a timestamp indicating a time and/or date at whichsaid biometric information was obtained.
 14. A method of discouragingphantom billing healthcare fraud comprising: providing a health careservice; in conjunction with providing said health care service at aparticular location to a patient, causing said patient to provide abiometric signature; capturing said biometric signature; creating anevent record that records said patient was at said particular locationat a particular time and/or date, said event record consisting of saidbiometric signature and location information indicating said particularlocation at which said biometric signature is obtained and at which saidhealth care service is provided wherein said event record is createdusing a computer system; transmitting said event record including saidbiometric signature to a computerized data store that is accessible by apayer entity; and storing said event record in said computerized datastore.
 15. A method of discouraging phantom billing healthcare fraudcomprising: providing a health care service; in conjunction withproviding said health care service at a particular location to apatient, causing said patient to provide a biometric signature;capturing said biometric signature; creating an event record thatrecords said patient was at said particular location at a particulartime and/or date, said event record consisting of a patient identifier,said biometric signature, and at least one timestamp indicating a timeand/or date at which said biometric signature is obtained and at whichsaid health care service is provided, wherein said event record iscreated using a computer system; transmitting said event recordincluding said biometric signature to a computerized data store that isaccessible by a payer entity; and storing said event record in saidcomputerized data store.
 16. A method of discouraging phantom billinghealthcare fraud comprising: providing a health care service; inconjunction with providing said health care service at a particularlocation to a patient, causing said patient to provide a biometricsignature; capturing said biometric signature; creating an event recordthat records said patient was at said particular location at aparticular time and/or date, said event record consisting of saidbiometric signature and at least one timestamp indicating a time and/ordate at which said biometric signature is obtained and at which saidhealth care service is provided and said event record indicates theabsence of phantom billing, wherein said event record is created using acomputer system; transmitting said event record including said biometricsignature to a computerized data store that is accessible by a payerentity; and storing said event record in said computerized data store.17. A method of discouraging phantom billing healthcare fraudcomprising: providing a health care service; in conjunction withproviding said health care service at a particular location to apatient, causing said patient to provide a biometric signature;capturing said biometric signature; creating an event record thatrecords said patient was at said particular location at a particulartime and/or date, said event record consisting of a patient identifier,said biometric signature, at least one timestamp, and locationinformation indicating said particular location at which said biometricsignature is obtained and at which said health care service is providedwherein said event record is created using a computer system;transmitting said event record including said biometric signature to acomputerized data store that is accessible by a payer entity; andstoring said event record in said computerized data store.
 18. A methodof discouraging phantom billing healthcare fraud comprising: providing ahealth care service; in conjunction with providing said health careservice at a particular location to a patient, causing said patient toprovide a biometric signature; capturing said biometric signature;creating an event record that records said patient was at saidparticular location at a particular time and/or date, said event recordconsisting of a patient identifier, said biometric signature, at leasttwo timestamps indicating a range of times at which said health careservice was provided, and location information indicating saidparticular location at which said biometric signature is obtained and atwhich said health care service is provided and said event recordindicates the absence of phantom billing, wherein said event record iscreated using a computer system; transmitting said event recordincluding said biometric signature to a computerized data store that isaccessible by a payer entity; and storing said event record in saidcomputerized data store.
 19. A method of discouraging phantom billinghealthcare fraud comprising: providing a health care service; inconjunction with providing said health care service at a particularlocation to a patient, causing said patient to provide a biometricsignature; capturing said biometric signature; creating an event recordthat records said patient was at said particular location at aparticular time and/or date, said event record consisting of a patientidentifier, said biometric signature, metadata, and location informationindicating said particular location at which said biometric signature isobtained and at which said health care service is provided and saidevent record indicates the absence of phantom billing, wherein saidevent record is created using a computer system; transmitting said eventrecord including said biometric signature to a computerized data storethat is accessible by a payer entity; and storing said event record insaid computerized data store.
 20. A method of discouraging phantombilling healthcare fraud comprising: providing a health care service; inconjunction with providing said health care service at a particularlocation to a patient, causing said patient to provide a biometricsignature; capturing said biometric signature; creating an event recordthat records said patient was at said particular location at aparticular time and/or date, said event record consisting of saidbiometric signature, location information, and at least one timestampindicating a time and/or date at which said biometric signature isobtained and at which said health care service is provided, wherein saidevent record is created using a computer system; transmitting said eventrecord including said biometric signature to a computerized data storethat is accessible by a payer entity; and storing said event record insaid computerized data store.
 21. A method of discouraging phantombilling healthcare fraud comprising: providing a health care service; inconjunction with providing said health care service at a particularlocation to a patient, causing said patient to provide a biometricsignature; capturing said biometric signature; creating an event recordthat records said patient was at said particular location at aparticular time and/or date, said event record consisting of saidbiometric signature, location information indicating a location at whichsaid biometric signature is obtained and at which said health careservice is provided, wherein said event record is created using acomputer system; transmitting said event record including said biometricsignature to a computerized data store that is accessible by a payerentity; and storing said event record in said computerized data store.